Provider Demographics
NPI:1962114652
Name:COCHRAN, LA'QITTA CHNELLE (LPN)
Entity type:Individual
Prefix:
First Name:LA'QITTA
Middle Name:CHNELLE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221289
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0997
Mailing Address - Country:US
Mailing Address - Phone:330-467-7131
Mailing Address - Fax:216-591-0223
Practice Address - Street 1:4325 GREEN ROAD
Practice Address - Street 2:COTTAGE 3
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-4884
Practice Address - Country:US
Practice Address - Phone:330-467-7131
Practice Address - Fax:216-591-0223
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.144919.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse